Background:

It remains unclear whether lateral joint space narrowing without severe cartilage loss before meniscal allograft transplantation (MAT) affects clinical outcomes and graft extrusion.

Hypothesis:

Patients with greater preoperative joint space narrowing would show more graft extrusion, more osteoarthritis progression, and worse clinical outcomes than would those with less narrowing.

Study Design:

Case-control study; Level of evidence, 3.

Methods:

We retrospectively evaluated 61 patients who underwent lateral MAT and had a minimum follow-up of 4 to 5 years. The median preoperative joint space width (JSW) on Rosenberg view radiographs was used to classify patients into those with less joint space narrowing (JSW ≥3 mm; group A) and greater joint space narrowing (JSW <3 mm; group B). We compared differences between groups in terms of graft extrusion and articular cartilage loss (modified Outerbridge grade ≥3) on 1-year postoperative magnetic resonance imaging (MRI) scans and changes in JSW and clinical outcomes at the last follow-up.

Results:

There were 31 patients in group A and 30 patients in group B; the mean follow-up time for all patients was 64.4 ± 10.3 months. All patients showed a significant preoperative to postoperative improvement in outcome scores (P < .001 for all). The mean preoperative JSW was 3.8 ± 0.9 mm in group A and 2.3 ± 0.4 mm in group B (P < .001). In group B, there was more graft extrusion on postoperative MRI scans (3.0 ± 0.9 vs 1.9 ± 0.6 mm, respectively; P < .001) and a higher proportion of patients with pathological graft extrusion at final follow-up (43.3% vs 12.9%, respectively; P = .011) compared with group A. At 1 year postoperatively, cartilage loss grade ≥3 was observed at the lateral femoral condyle in 3.2% and 20.0% of patients in groups A and B (P = .053), respectively, and at the lateral tibial plateau in 3.2% and 30.0% of patients (P = .006), respectively. There were moderate correlations between graft extrusion and preoperative absolute JSW (r = –0.471; P < .001) and preoperative relative JSW (r = –0.428; P = .001).

Conclusion:

Patients with less preoperative joint space narrowing had less graft extrusion and cartilage loss on 1-year postoperative MRI scans, as well as better radiological and clinical outcomes at midterm follow-up, compared with patients with greater preoperative narrowing.

中文翻译：

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术前关节间隙宽度对外侧半月板同种异体移植的影响：中期随访结果

背景：

目前尚不清楚在半月板同种异体移植（MAT）之前没有严重软骨损失的外侧关节间隙狭窄是否会影响临床结果和移植物挤压。

假设：

与狭窄程度较小的患者相比，术前关节间隙狭窄程度更大的患者会表现出更多的移植物挤压、更多的骨关节炎进展和更差的临床结果。

学习规划：

病例对照研究；证据水平，3。

方法：

我们回顾性评估了 61 名接受侧位 MAT 并至少随访 4 至 5 年的患者。使用 Rosenberg X 片上的术前关节间隙宽度中位数（JSW）将患者分为关节间隙狭窄较小（JSW ≥3 mm；A 组）和关节间隙狭窄较大（JSW <3 mm；B 组）的患者。我们比较了术后 1 年磁共振成像 (MRI) 扫描中移植物挤压和关节软骨损失（改良 Outerbridge 等级≥3）以及最后一次随访时 JSW 和临床结果的变化方面的组间差异。

结果：

A组31例，B组30例；所有患者的平均随访时间为 64.4 ± 10.3 个月。所有患者的术前至术后结果评分均有显着改善（所有患者均P < .001）。A 组平均术前 JSW 为 3.8 ± 0.9 mm，B 组为 2.3 ± 0.4 mm ( P < .001)。在 B 组中，术后 MRI 扫描中有更多的移植物挤压（分别为 3.0 ± 0.9 vs 1.9 ± 0.6 mm；P < .001），并且在最终随访时出现病理性移植物挤压的患者比例更高（43.3% vs 12.9 %，分别；P= .011) 与 A 组相比。术后 1 年，在 A 组和 B 组中分别有 3.2% 和 20.0% 的患者在股骨外侧髁处观察到 ≥3 级软骨丢失 ( P = .053)，在分别有 3.2% 和 30.0% 的患者出现胫骨平台外侧平台 ( P = .006)。移植物挤压与术前绝对 JSW ( r = –0.471; P < .001) 和术前相对 JSW ( r = –0.428; P = .001) 之间存在中度相关性。

结论：

与术前狭窄较大的患者相比，术前关节间隙狭窄较少的患者在术后 1 年的 MRI 扫描中移植物挤压和软骨损失较少，并且在中期随访时影像学和临床结果较好。